Showing papers in "Italian Journal of Public Health in 2005"
TL;DR: The IOM report “To Err is Human” proposes an approach for reducing medical errors and improving patient safety by designing processes that are able to ensure that patients are safe from accidental injury.
Abstract: Human beings, make errors Healthcare Services is a complex industry prone to accidents.The IOM Report [1] points out that some systems are more prone to accidents than others. When a system fails there are often multiple faults. In healthcare,human errors are the greatest contributors to accidents,however when human error is to blame it often depends upon failures within the system.These failures exists in the system before the error occurs, the same as with latent errors which are difficult to identify since they may be hidden in computers or within the various managerial layers. Most of the errors can be prevented by designing systems that make it hard for people to do the wrong thing and easy for people to do the right thing. In healthcare, this means designing processes that are able to ensure that patients are safe from accidental injury. As healthcare and the system that delivers it become more complex, the opportunities for errors abound. The IOM report “To Err is Human” proposes an approach for reducing medical errors and improving patient safety.The environment within which this occurs has a critical influence on quality.This influence may contain two dimensions; the first consists of the domain of quality which includes the practice that is consistent with current medical knowledge. The second dimension consists of forces in the external environment that can drive quality improvement in the delivery system. Although the risk of dying as a result of a medical error, far surpasses the risk of dying in an airline accident, public attention has been more focused on improving safety in the airline industry than in healthcare systems. Because of the absence of standardized nomenclature, it is important to define what an error is and what is an adverse event, the IOM Report defines them in the following way: “An error is the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim.” An adverse event is an injury caused by medical management rather than the underlying condition of the patient. An adverse event attributable to error is a “preventable adverse event”.
2,527 citations
TL;DR: A number of core challenges emerge across many European countries including the need to continue to build strong political will and commitment to address patient safety problems, stronger engagement and leadership from health care professionals, and promoting positive cultural changes with health care.
Abstract: Despite enormous strides in our knowledge about quality health services, and the continuously growing interest in the safety of patients among policy makers and clinical leaders, much remains to be done to avoid unintentionally harm occurring in health care. In May 2004, the Fifty-seventh World Health Assembly supported the creation of the World Alliance for Patient Safety which aims to coordinate, spread and accelerate improvements in patient safety worldwide. The Forward Programme 2005 of the World Alliance for Patient safety sets out an important and comprehensive programme of international work in areas such as reporting and learning, patient involvement and safety solutions. The experience of other high risk industries, suggests that patient safety problems are primarily a function of deficiencies in system design, organization and operation. Understanding and improving the design of processes, structures and culture of health care delivery is therefore central to making care safer. A number of core challenges emerge across many European countries including the need to continue to build strong political will and commitment to address patient safety problems, stronger engagement and leadership from health care professionals, and promoting positive cultural changes with health care.
57 citations
TL;DR: This book describes the important role that epidemiological methods play in the continuum from gene discovery to the development and application of genetic tests, and calls this continuum human genome epidemiology (HuGE) to denote an evolving field of inquiry that uses systematic applications of Epidemiological methods to assess the impact of human genetic variation on health and disease.
Abstract: Human health is determined by the interplay of genetic factors and the environment. In this context the recent advances in human genomics are expected to play a central role in medicine and public health by providing genetic information for disease prediction and prevention. After the completion of the human genome sequencing, a fundamental step will be represented by the translation of these discoveries into meaningful actions to improve health and prevent diseases, and the field of epidemiology plays a central role in this effort. These are some of the issues addressed by Human Genome Epidemiology –A scientific foundation for using genetic information to improve health and prevent disease, a volume edited by Prof. M. Khoury, Prof. J. Little, Prof.W. Burke and published by Oxford university Press 2004. This book describes the important role that epidemiological methods play in the continuum from gene discovery to the development and application of genetic tests. The Authors calls this continuum human genome epidemiology (HuGE) to denote an evolving field of inquiry that uses systematic applications of epidemiological methods to assess the impact of human genetic variation on health and disease. The book is divided into four sections and it is structured to allow readers to proceed systematically from the fundamentals of genome technology and discovery, to the epidemiological approaches, to gene characterisation, to the evaluation of genetic tests and their use in health services and public health.
24 citations
TL;DR: The 4 year - experience of A. Gemelli University Hospital of applying HTA methodologies is outlined, which shows that HTA’s methods are now becoming imperative also on an organizational level, as a valuable tool to support managerial decisions.
Abstract: The Italian National Health Care Service, as many other industrialised countries’, has to cope with increasing health care needs in spite of the limited resources available. Therefore, it is necessary to assess diagnostic-therapeutic procedures, technologies and organizational standards, in order to allocate the available resources appropriately. Methodologies developed by the area of research known as Health Technology Assessment, provide scientific support for the policies that all countries have adopted in order to rationalize, and sometimes to ration, health care services. Within this context Health Technology Assessment plays a key role in establishing appropriate health care policy decisions. If in the past Health Technology Assessment’s areas of applications have involved mainly macro health care policies, HTA’s methods are now becoming imperative also on an organizational level, as a valuable tool to support managerial decisions. This article outlines the 4 year - experience of A. Gemelli University Hospital of applying HTA methodologies.
22 citations
TL;DR: Patients have a right to expect that every effort is made to ensure their safety as users of all health services, and the health care sector still lags behind other industries and services that have introduced systematic safety processes.
Abstract: Access to high quality healthcare is a key human right recognised and valued by the European Union, its Institutions and the citizens of Europe. Accordingly, patients have a right to expect that every effort is made to ensure their safety as users of all health services. Background :The health sector is a high-risk area because adverse events,arising from treatment rather than disease, can lead to death, serious damage, complications and patient suffering. Although many hospitals and healthcare settings have procedures in place to ensure patient safety, the health care sector still lags behind other industries and services that have introduced systematic safety processes. A number of investigations from all over the world have underlined the need for and the possibility of reducing the number of adverse events in the health sector. Current data show that almost half of all preventable adverse events are a consequence of medication errors.
10 citations
TL;DR: Evaluated molecular techniques as an alternative tool in order to identify Listeria monocytogenes meningitis using RT-PCR and conventional PCR and revealed that signal intensity decreased by 40%, 80% and 100% at day 15, 30 and 55 respectively, from the start of antibiotic treatment.
Abstract: Background . Listeria monocytogenes is one of the most important human foodborne pathogens; it may be responsible for several disorders, like meningoencephalitis. Listerial isolation in cerebrospinal fluid (CSF) is often difficult using microbiologic traditional assays. The aim of this study is to evaluate the reliability of molecular techniques as an alternative tool in order to identify Listeria monocytogenes meningitis and in particular, to evaluate a real-time PCR and a conventional PCR for the target hlyA gene. Methods . In 2000-2004, 145 patients, without T-cell immunodeficiency, affected by meningoencephalitis of unknown origin were admitted to the Infectious Diseases Institute of Sassari, Italy; a lumbar puncture was performed at the time of hospital admission. Two different PCR techniques, i.e. RT-PCR and a conventional PCR, were performed in order to detect CNS listerial infection, in conjunction with traditional microbiologic assays. Results . We identified fourteen patients affected by listerial meningitis using RT-PCR and conventional PCR. All but one of the CSF cultures were negative for L. monocytogenes. Molecular techniques were performed on the CSF samples collected during follow-up revealing that signal intensity decreased by 40%, 80% and 100% at day 15, 30 and 55 respectively, from the start of antibiotic treatment. Conclusions . Considering the seriousness of CNS involvement caused by L. monocytogenes infection, prompt diagnosis is necessary in order to rapidly start specific treatment. Conventional PCR and RT-PCR are rapid assays for L. monocytogenes diagnosis and they might be useful for monitoring the efficacy of antibiotic therapy
10 citations
TL;DR: Benzodiazepine use was associated with patient characteristics, such as being female, using analgesics or antidepressants and the presence of a chronic disease especially cancer or chronic heart failure.
Abstract: Background . Benzodiazepines are among the most commonly prescribed drugs in Italy and they are often used inappropriately according to guidelines for their rational use. The aim of this study was to investigate the prevalence and pattern of use of benzodiazepine amongst the general population aged 65-84 years in the Friuli-Venezia Giulia Region, in North-East Italy. Methods . A total of 40 general practitioners participated in the study. Two data sources were used in the research. The first was the Health Search Database, the second was a short questionnaire administered by the general practitioners to the 65 to 84 year old patients attending their surgeries for any reason during the study period. Data on the use of benzodiazepines between 1st February and 31st July 2001 were extracted from both the Health Search Database using drug prescriptions and the questionnaires. Results . Of the 10,468 patients aged 65-84 years with complete demographical data in the general practitioners’ patient lists, 2,369 subjects used benzodiazepines, hypnotics and over the counter drugs. Overall prevalence of benzodiazepine use was 21.5% (95% confidence interval: 19.8-23.1%). Of the benzodiazepine users, 66.9% consumed a short-intermediate half-life and 33.1% a long half-life benzodiazepine. Most patients took benzodiazepines at night (68.2%), less frequently in the daytime and at night (23.7%), or in the daytime only (8.1%). Most users (89.2%) said they had been taking benzodiazepine for years. Conclusions . Benzodiazepine use was associated with patient characteristics, such as being female, using analgesics or antidepressants and the presence of a chronic disease especially cancer or chronic heart failure.
7 citations
TL;DR: Information on the epidemiology of trichothecene producing Fusarium through the food chain and the identification of the most frequently contaminated components of fast food are essential in order to develop effective public health strategies for minimising consumer exposure to trICHothecenes.
Abstract: Background . Food contamination by trichothecene mycotoxins is considered to be an emerging public health problem. The aim of this study was to validate a rapid sonification protocol, previously set up for cereal Fusarium DNA extraction from fast food samples, produced by a centre for research and development in the food industry in Catania, Sicily, and to validate it for a diagnostic PCR assay targeted at tri5, the key gene of trichothecene biosynthesis. Methods . DNA from reference Fusarium spp. strains and from fast food samples was prepared, setting up an extraction protocol adapted using some modifications based on a method recently described. Validation experiments were performed: serial dilution of DNA extracted from fungal cultures were added to food samples and then DNA was extracted. Specific primer pairs were used to detect F. graminearum and F. culmorum DNA in species-specific assays as well as trichothecene-producing Fusarium spp. in a groupspecific system. Results . All genomic DNA extracted from trichothecene-producing Fusarium spp. as well as from DNA-spiked fast food samples and from food still in it’s original condition resulted in the correct amplification. The detection limit was 1 x 10-4 μg of DNA. All fungal and food samples tested gave highly consistent results in repeatability assays, thus demonstrating the within-lab and within/between-day precision of the method. Conclusions . Information on the epidemiology of trichothecene producing Fusarium through the food chain and the identification of the most frequently contaminated components of fast food are essential in order to develop effective public health strategies for minimising consumer exposure to trichothecenes. Key words: Fusarium, fast food, trichothecenes, PCR
6 citations
TL;DR: The NHS Report aims to provide a guide to current knowledge of the frequency, nature and causes of errors, the risk factors inherent in current medication processes and helping the NHS organizations and health professionals in achieving a reduction in serious medication errors.
Abstract: Medication errors occur in all health care systems and in all health care settings If the errors are identified through an active management and effective reporting system they can be removed before they can cause harm to patients In order to reduce the risk it is important to understand the causes of medication errors The NHS Report aims to provide a guide to current knowledge of the frequency, nature and causes of errors, the risk factors inherent in current medication processes and helping the NHS organizations and health professionals in achieving a reduction in serious medication errors In July 2001 the UK Government established the National Patient Safety Agency (NPSA, http:// wwwnpsanhsuk) which, in 2004, implemented a national reporting and learning system to enable the NHS to report all type of adverse incidents including those involving medicines The NPSA core purpose is to improve patient safety and to accomplish this task; it looks at the identification of patterns and trends in avoidable adverse events so that the NHS can entrust practice and management to reduce the risk of recurrence Before the establishment of the NPSA, there had been no attempt to establish a unified mechanism for reporting and analyzing medication errors Despite the many published studies there is no clear definition for medication errors and thus they do not distinguish between errors and adverse drug reactions The Report defines and highlights the differences between medical errors and drug reactions
6 citations
TL;DR: The process that lead to the passing of the Act for Patient Safety in the Danish health care system, the contents of the act and how the act is used are described and there is room for improvement.
Abstract: This paper describes the process that lead to the passing of the Act for Patient Safety in the Danish health care system, the contents of the act and how the act is used in the Danish health care system. The act obligates frontline health care personnel to report adverse events, hospital owners to act on the reports and the National Board of Health to communicate the learning nationally. The act protects health care providers from sanctions as a result of reporting. In January 2004, the Act on Patient Safety in the Danish health care system was put into force. In the first twelve months 5740 adverse events were reported. The reports were analyzed locally (hospital and region), anonymized and then sent to the National Board of Health. The Act on Patient Safety has driven the work with patient safety forward but there is room for improvement. Continuous and improved feedback from all parts of the system is essential to maintain the level of reporting.
5 citations
TL;DR: The following describes this new approach and the experiences in Lombardy where various solutions have been adopted to support and improve Health Technology Assessment processes.
Abstract: Italy is dealing with an early stage of Health Technology Assessment diffusion. In our opinion, there are at least three important dimensions related to Health Technology Assessment (strategy, inter-organisational relationships and governance) that are able to affect it, at each level, systemic and operating-unit related. Although Health Technology Assessment may have originated as a centralised function conducted by federal government agencies or other national/regional organisations, it is an increasingly decentralised activity. In Italy this decentralisation process is now reaching a peak because of the almost total assignment of health responsibilities to regional authorities. Moreover, Health Technology Assessment is interdisciplinary and it is interdependent with innovation processes. The context seems to be very complex: in our opinion a flexible approach is advisable. The following describes this new approach and the experiences in Lombardy where various solutions have been adopted to support and improve Health Technology Assessment processes
TL;DR: The result suggests that the NAT2 slow genotype has probably no effect on the risk of gastric cancer and additional epidemiological studies are required to confirm these findings.
Abstract: In recent studies N- Acetyltransferase 2 (NAT2) genotype has been considered as a risk factor for developing gastric cancer, however with conflicting results among Asian and Caucasian populations. In order to clarify the influence of NAT2 slow acetylation status on gastric cancer risk, a preliminary meta-analysis of published case-control studies was undertaken. The primary outcome measure was the odds ratio (OR) for the risk of gastric cancer associated with the NAT2 slow genotype using a random effects model. Pooling the results from the 5 studies identified (771 cases, 1083 controls), an overall OR for gastric cancer risk associated with the NAT2 slow genotype of 0.91 emerged (95% CI: 0.54-1.55). The result suggests that the NAT2 slow genotype has probably no effect on the risk of gastric cancer. Additional epidemiological studies, based on sample sizes that are commensurate with the detection of small genotypic risks, are required to confirm these findings. Future studies may also help to clarify whether geographic differences exist.
TL;DR: In this article, the authors explore the relationship between traffic accident mortality and factors such as road behaviour, vehicles and road characteristics, four different linear regression models were performed using data from the end of the 1990's provided by the National Institute of Statistics (ISTAT) and from the Automobile Club Italia (ACI).
Abstract: Traffic accidents represent an important public health issue in Italy. In order to explore the relationship between traffic accident mortality and factors such as road behaviour, vehicles and road characteristics, four different linear regression models were performed using data from the end of the 1990’s provided by the National Institute of Statistics (ISTAT) and from the Automobile Club Italia (ACI). In Italy regional differences in traffic mortality and injury rates can be observed. Strong predictors are the number of motor vehicles circulating and road length (inversely associated) and the number of new vehicles circulating and suspended driving licenses (directly associated).
TL;DR: Clustering of the strains by SE-AFLP and PFGE is very similar, but the first technique is more rapid and user-friendly and does not require sophisticated equipment, which suggests it could be a promising support to epidemiological investigations.
Abstract: Serotype Enteritidis is still the main serotype infecting humans and poultry worldwide. Subtyping of isolates belonging to this serotype is difficult, because of the wide clonal circulation of a few bacterial clones. This study presents the results of the characterization of 49 isolates of S. Enteritidis identified at the southern Italy Centre for Enteric Pathogens (CEPIM) during the years 2002-2003 by the methods of Pulsed Field Gel Electrophoresis (PFGE) and Single-Enzyme Amplified Fragment Length Polymorphism (SE-AFLP). Clustering of the strains by SE-AFLP and PFGE is very similar, but the first technique is more rapid and user-friendly and does not require sophisticated equipment. Further work is needed for a more accurate assessment of SEAFLP, but preliminary results suggest it could be a promising support to epidemiological investigations.
TL;DR: Traditional epidemiological indicators are inadequate to target prospective concurrent reviews and Qualitative studies focusing on patient physician dialogue in different situations and contexts could widen understanding of the problem and suggest new theoretical frameworks and theories to provide more detailed explanations.
Abstract: Objectives . To identify 1) the characteristics of patients receiving non acute (inappropriate) care and 2) the variables associated to inappropriate hospital use, in order to 3) estimate the relevance of the problem and to 4) focus future concurrent reviews and efforts to allocate patients to alternative health care settings. Design . A prospective review of a random sample of adult patients who presented to the Emergency Department of the Molinette Hospital. Patients were assessed at admission and on day 3, 5and 8 using the Appropriateness Evaluation Protocol (Italian validated version). Patients: 490 overall; 312 (64 %) medical and 178 (36 %) surgical. Outcome measures . Acute (appropriate) and non acute (inappropriate) admissions, Major Disease Category, costs, mean weights of Diagnosis Related Groups, and length of stay (days). Results . The proportion of patients requiring acute care declined rapidly from presentation (84.5%) to the fifth day of admission (60.9%). Patients admitted during weekends showed a higher rate of inappropriate stay on day 5 (P=0.04). The proportion of inappropriate admissions was higher for medical rather than surgical patients (P=0.07) at presentation and at day 5 (P < 0.01). Traditional social-demographic variables were not significant risk indicators for inappropriate admissions. The likelihood ratio for inappropriate admission at presentation was significantly higher for minor illnesses and disturbances (P=0.03). Inappropriate stay on day 5 was significantly associated with lower cost (P < 0.01), lower mean DRG weight (P < 0.01) and shorter length of stay (P=0.05) for medical but not for surgical admissions. Conclusions . Traditional epidemiological indicators are inadequate to target prospective concurrent reviews. Qualitative studies focusing on patient physician dialogue in different situations and contexts could widen our understanding of the problem and suggest new theoretical frameworks and theories to provide us with more detailed explanations.
TL;DR: These more recent studies represent an important progress because the Harvard study is considered old in its approach describing errors as the result of negligence or misconduct and missing totally the problems of the medical environment (the system approach).
Abstract: In 1991 the publication of the Harvard Medical Practice Study gave a new light to the problem of patient safety. Because of its rigorous methodology, its dimensions (more than 30,000 clinical records from 51 hospitals) and number and variety of the departments involved (medicine, surgeries, emergence, etc) the Harvard study represents a milestone in the patient safety research. It unequivocally demonstrated that errors happen in the hospitals, they can be life-threatening and most of them are preventable. A wide number of other reports have followed the Harvard study, most of them refer to hospitals while the rate of errors in primary care is less known.These more recent studies represent an important progress because the Harvard study is considered old in its approach describing errors as the result of negligence or misconduct and missing totally the problems of the medical environment (the system approach).
TL;DR: The integrated surveillance approach described in this study is able to clarify the complex epidemiology of ICU-acquired infections and can provide important cues for prevention and control activities.
Abstract: Background . Nosocomial infections contribute substantially to increased morbidity, mortality and resource expenditure in Intensive Care Units (ICUs). Methods . A one-year prospective surveillance study was performed using epidemiological and microbiological methods to quantify the frequency of infections and the antimicrobial usage, microbiological environmental sampling and molecular typing of clinical and environmental isolates. Results . The frequency of ICU-acquired infections was comparable to other Italian ICUs. Most of these infections were caused by few epidemic clones of Pseudomonas aeruginosa, methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii. The survival advantage of these epidemic clones over the sporadic isolates may be related to the multi-resistant profile of the epidemic clones and to the high usage of some antibiotics in the ICU. Hand contamination of ICU personnel is a likely factor for dissemination of epidemic clones within the ICU. Conclusions . The integrated surveillance approach described in this study is able to clarify the complex epidemiology of ICU-acquired infections and can provide important cues for prevention and control activities.
TL;DR: Much remains to be done to achieve safer care for patients across Europe, and action at the European level has a vital role to play in ensuring that safe care is a core part of health system improvements in all countries.
Abstract: Healthcare has been relatively slow in comparison to other industries to recognize itself as a high risk activity. Recent estimates suggest that 1 in 10 patients admitted to hospital experience some form of unintended harm. In both human and economic terms, the need to reduce these unacceptable levels of harm is impossible to ignore. Patient safety is a serious concern for many EU Member States. This has been given impetus by both the UK and Luxembourg Presidencies of the European Union, both of which have made patient safety a headline health priority theme. The overriding aims of patient safety activity during the UK Presidency have been to ensure that: • patient safety becomes a key priority on the European health agenda, both at EU level and in individual Member States there are concrete mechanisms and practical programmes of activity established at the EU level to take forward patient safety issues • Activity at the European level also aims to build upon the programme established by the World Health Organization through the World Alliance for Patient Safety and the work of other key partners. Much remains to be done to achieve safer care for patients across Europe. Action at the European level has a vital role to play in ensuring that safe care is a core part of health system improvements in all countries. Safe care can never be an optional extra; it is the right of every patient who entrusts their care to our health care systems.
TL;DR: This initiative, involving the participation of all personnel, has produced a measurable improvement in safety of both patients and staff and represents a step from the promotion and dissemination phase to that of a formal organic risk management system in medicine.
Abstract: Introduction The risk management project of The University Hospital “A. Gemelli” aims to define the necessary procedures to manage clinical risk, by identifying the structures involved within this process, so that all of the personnel can contribute to a measurable improvement in the safety of both patients and staff. Methods The Risk Management Program is comprised of 5 long-term phases: Phase 1 - Strategy Definition and Communication: a clear and shared Risk Management Strategy is indispensable to guarantee a coordinated action plan, in order to focus all of the interventions towards the achievement of common and measurable results. Phase 2 - Risk Management System Governance: all of the organisational structures have been activated in order to effectively manage the Risk Management System. The system has been introduced to interact within all areas of the hospital and to transfer information. Phase 3 - Promotion within the Organisation: this phase fosters the aims of the project within the whole organisation, by stressing the concept of “learning from errors”. This is crucial if organisational and healthcare workers are to understand the true aims of risk prevention and protection and offer to contribute to the process. Phase 4 - Risk Assessment: a data survey system was created and institutionalized. This phase begins with an analysis of the information flow, in order to estimate the probabilities that certain risks occur, and ends with defining the interventions to undertake. Risk assessment makes it possible to forecast the consequences of certain risks and thus prioritise those for prevention. Phase 5 - Risk Management: this consists of planning and implementing all of the actions necessary to prevent risks, protect and finance (in terms of prevention) A. Gemelli University Hospital. Results The results achieved are remarkable especially when one considers the organisation of a complex clinical risk management system within a large university hospital. An information flow that examines and identifies risks from surveying the data has been created. Preventative activities have been planned in the laboratories, transfusion and pharmacotherapy sectors as outlined in the risk map, together with clinical audit activities. Furthermore, all of these issues have been highlighted across all sectors with the creation of an accredited ECM training program as well as the implementation of an anonymous survey. These initiatives have not only increased the interest in Risk Management issues, but have also fostered the integration of different groups and their working methods. Conclusions Introducing risk management processes to A. Gemelli University Hospital represents a step from the promotion and dissemination phase to that of a formal organic risk management system in medicine. This initiative, involving the participation of all personnel, has produced a measurable improvement in safety of both patients and staff.
TL;DR: The issue of patient safety is seen as a priority by EU institutional bodies and by many European health stakeholders.
Abstract: Since the Harvard Medical Practice Study was published in 1991 the growing mass of international literature has demonstrated that medical adverse events can cause iatrogenic illnesses, prolonged hospitalisations and increased costs. In 1999-2001, reports made by the Institute of Medicine (IOM) in the USA, the Department of Health (DoH) in the UK and the Australian Patient Safety Foundation (APSF) stressed the necessity for creating a safer environment and a reporting culture throughout healthcare systems. They also emphasized the need for researchers to investigate means of turning policies into practice. Since their publication a lot of effort has gone into collecting data on adverse events and near misses. As a result, in 2001, the AHRQ published a Health Technology Assessment report on best practices for patient safety. While in Australia national meetings have been dedicated to address important issues across the whole spectrum of healthcare. In the UK the Audit Commission has published a report that is also focused on medication safety: “A spoonful of sugar”. In 2004 the World Health Organisation promoted a Patient Safety Alliance; while in April 2005the Standing Committee of European Doctors organised a Conference in Luxembourg called “Patient safety - Making it happen!”. The issue of patient safety is therefore seen as a priority by EU institutional bodies and by many European health stakeholders.
TL;DR: The biomolecolar system adopted appeared to be useful to supplement existing tests for the final identification of rough presumptiveSalmonella isolates, for the rapid screening of food samples and the quick identification of Salmonella spp.
Abstract: In order to evaluate the presence of Salmonella spp. in ready-to-eat foods, sixty-nine samples were analyzed using the BAXR system for Screening/Salmonella, a quick method based on PCR technology, and conventional culture procedures. Both methods showed the absence of Salmonella spp. in all samples and positive results for one sample artificially contaminated by a strain of Salmonella enteritidis, showing a full agreement. The biomolecolar system adopted appeared to be useful to supplement existing tests for the final identification of rough presumptive Salmonella isolates, for the rapid screening of food samples and the quick identification of Salmonella spp.
TL;DR: A study was initiated in Dutch hospitals investigating the nature and extent of adverse events and their causes, and two important goals of the Dutch study are to reach a consensus on basic concepts and to improve research methodology.
Abstract: In various studies outside the Netherlands, it has been shown that a substantial number of patients suffer from some kind of harm during their treatment in hospital. The incidence of these so-called adverse events varies between 2.9% and 16.6%; it is estimated that between over a quarter and a half of these are considered to be avoidable. Preventable adverse events can be considered to be a starting point for interventions to increase patient safety. In response to this, a study was initiated in Dutch hospitals investigating the nature and extent of adverse events and their causes. Lessons learnt will be discussed within the European Research Network on Quality in Health Care (ENQual), where researchers and policy makers come together to exchange knowledge and experiences. Two important goals of the Dutch study are to reach a consensus on basic concepts and to improve research methodology. An unintended event resulting in harm caused by healthcare is called an adverse event in international literature. Preventable adverse events are especially important for prevention, in these cases the harm can be attributed to unintended events in the care process, caused by insufficient action according to professional standards and failures within the care system. Most adverse events, caused as they may seem by human action or failing to act at first sight, are often partly caused by a care process that has not been properly organized. Uniform concepts are needed in order to facilitate European comparisons, which would allow, for example, the comparison of Dutch research results with those from other countries, and the identification of specific concepts. One of the six action areas of the WHO’s World Alliance for Patient Safety is the development of a ‘patient safety taxonomy’.
TL;DR: This paper addresses the various nomenclature and taxonomies of error within healthcare as well as the incidence, risk factors, causes, and prevention of medication errors.
Abstract: The morbidity and mortality of drug-related problems has most recently been estimated to cost $177.4 billion annually within the United States alone. Empirical investigations have also suggested that almost one-fifth of all medical errors are drug-related within hospital settings, with over half of these being of a preventable nature. As such, minimizing medication errors has emerged as a priority area to ensure patient safety within healthcare systems worldwide, as several nations have implemented broad initiatives to improve the medication use system. Due to the numerous complexities involved, multifaceted and systemwide approaches to redesigning processes are most often advocated. Given the importance of appropriate medication use in achieving optimal patient outcomes, this paper addresses the various nomenclature and taxonomies of error within healthcare as well as the incidence, risk factors, causes, and prevention of medication errors.
TL;DR: The results confirm previous ribotyping data regarding the validity of the presently recognised nomenspecies within the genus Proteus, but provides further evidence for the existence of genetic differences within the P. vulgaris species.
Abstract: Background . The genetic relationship among different species within the genus Proteus has still not been clarified and previous studies by rRNA gene restriction patterns (ribotypes) suggested a high genetic variability in the presently recognised nomenspecies. Methods . The usefulness of rpoB sequencing for inter- and intraspecies discrimination in the genus Proteus was evaluated on 11 type and clinical strains belonging to the four described species: P. penneri, P. vulgaris, P. mirabilis, and P. myxofaciens. Results . The rpoB sequencing proved able to characterise the different species, showing six well defined rpoB sequence groups in the 1153 bp region analysed. P. myxofaciens and P. mirabilis could be clearly differentiated from the types and clinical strains of the other species showing sequence divergences of 19.5- 23% and 6.6-7.6%, respectively. Two groups of P. vulgaris sequences could be described, one of them including the new strain type, differing from each other by 3.3-3.6% of their nucleotides (nt) and for both of them 6.5-6.8% nt differences from the stand-alone former P. vulgaris strain type were found. P. penneri differed by only 2.3-3% from all P. vulgaris strains, however, differed from the former P. vulgaris strain type by 5.5-5.8%. Conclusions . Our results confirm previous ribotyping data regarding the validity of the presently recognised nomenspecies within the genus Proteus, but provides further evidence for the existence of genetic differences within the P. vulgaris species.
TL;DR: A system of regular feedback to staff was introduced to encourage continued reporting and heightened awareness of medication safety issues and a root cause analysis was undertaken and action plans were developed by collaboration between the MSF and ward staff.
Abstract: Background In line with international trends, patient safety has become a priority health issue in the Irish healthcare system in recent years. In August 2004, a medication safety facilitator (MSF) was appointed in an acute teaching hospital in Ireland for the investigation of medication safety events (MSEs). Methods The MSF designed a pilot medication safety reporting system for trial in three ward areas over seven months. The system was subsequently expanded to the entire hospital. Results During the first year of the appointment of the MSF, reporting levels increased by 290% relative to the same period the previous year. The majority of reports involved potential risks, near misses and medication errors that reached the patient but caused no discernable harm. For the more serious events, a root cause analysis was undertaken and action plans were developed by collaboration between the MSF and ward staff. A system of regular feedback to staff was introduced to encourage continued reporting and heightened awareness of medication safety issues. Proactive safety reviews were undertaken for high-risk medications, resulting in the introduction of system changes to optimise safety. Guidance was provided to staff in the form of bulletins, alerts and education sessions. Future plans Expansion plans for the second year of the project involve the development of a network of safety champions across the hospital. These individuals will undergo root cause analysis training and then liaise with the MSF with regard to the communication of safety messages and the implementation of action plans.
TL;DR: The expression patterns described confirm the role for these apoptosis genes in gastric adenocarcinoma and observe a significant suppression of bax with an increase of bcl-XL at protein and mRNA levels.
Abstract: Background . Evidences indicate an involvement of apoptosis related genes in gastric carcinogenesis. We studied the gene and protein expression patterns of bcl-2, bax and bcl-X in samples of gastric adenocarcinoma. The apoptotic index values, histological type, differentiation grade, cancer stage and lymph node status were statistically analysed for possible correlations with expressional data. Methods . Thirty specimens of gastric cancer and respective normal control gastric mucosa were collected from patients with the diagnosis of gastric adenocarcinoma who underwent a curative gastrectomy. bcl-2, bax and bcl-XL mRNA and protein levels were respectively determined by reverse transcription PCR (RT-PCR) and western blot using monoclonal antibodies for immunodetection. Results and conclusions .We observed a significant suppression of bax with an increase of bcl-XL at protein and mRNA levels. The presence of lymph node metastases was statistically related to the loss of bax overexpression. Bcl-XL was mostly up-regulated in intestinal/mixed types of gastric carcinoma. The expression patterns described confirm the role for these apoptosis genes in gastric adenocarcinoma.
TL;DR: The Luxembourg Declaration is a launching pad for European progress in this field as it sets important goals and demonstrates the steps to be undertaken and gives us hope for measurable progress in the future.
Abstract: Services provided for European citizens’ healthcare are not services like standard commercial services. Healthcare services need to be accessible, independent of the citizen’s economic or social background and should at the same time be available to all at the best possible quality level. The Luxembourg Declaration on Patient Safety recognizes these challenging fundamental principles. Patient safety is a key aspect for all European policy makers, as it is a vital question of equitable access to health care. Nevertheless we know that unfortunately a considerable amount of avoidable safety events still occur all across Europe! However differently organized our national health systems may be, it is vital to share experience and knowledge at a European level in order to be able to learn from the experiences of the different memberstates. No uniform solution can be found and decreed from the bottom down, nevertheless Europe can contribute and help to raise standards by a common effort. The Luxembourg Declaration is a launching pad for European progress in this field as it sets important goals and demonstrates the steps to be undertaken. It is a calling and gives us hope for measurable progress in the future.
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TL;DR: In this article a current European multi-national project in patient safety is described, which began in Feb. 2005 and will run for two years and is comprised of four main elements, including a mapping exercise to determine the present status of patient safety activity within at least 20 European countries.
Abstract: In this article a current European multi-national project in patient safety is described. This project began in Feb. 2005 and will run for two years. It is managed by a consortium of seven NGO’s led by the CBO (Dutch Institute for Healthcare Improvement) and receives 60%of its funding from DGSANCO (the health and social policy division of the European Commission). The policy framework within which the project evolved is also described. Despite the constraints of Art 152 of the Treaty, support from Commissioner Byrne encouraged a High Level Reflection process (HLRP) on patient mobility and healthcare developments in the EU, which started in June 2002 and involved European Health Ministers. As a result a series of very positive recommendations were made at the end of 2003 which subsequently were accepted and have affected policy direction in a number of areas e.g. co-operation on e-health, better use of resources as well as quality issues such as patient safety and quality implications of cross-border patient flows. The paper then reviews current issues in patient safety activity within Europe. Finally the Simpatie project is described. It is comprised of four main elements. First, a mapping exercise to determine the present status of patient safety activity within at least 20 European countries. It utilises extensive existing networks within and between the members of the consortium and other relevant stakeholders within Europe. Secondly, a “tool-box” exercise attempts to define common terminology and an expert consensus on measurement tools. This is complemented by the third element, a strategy component which aims to define the basic elements of different approaches to implementing patient safety within health systems. Finally, the last element is dissemination, where involvement of both public and health user organisations will be an important component.
TL;DR: With additional refinements on their clinical specificity, increased stability in their definitions over time to permit long-term monitoring and country interest within organizations such as the OECD to build on the existing scientific work of these indicators, their to help answer questions about patient safety worldwide will be significantly enhanced.
Abstract: There is a lot of interest in patient safety, but there is still little useable national level information on the actual magnitude of patient safety problems that can be used by providers and policy makers to judge performance. The AHRQ Patient Safety Indicators (PSIs) are a set of measures that can be used with hospital inpatient administrative (discharge) data to provide a perspective on patient safety. They screen for problems that patients experience as a result of exposure to the healthcare system and that are likely amenable to prevention by changes at the system or provider level. There is a growing interest in the possible use of the AHRQ PSIs in international settings. The Organization for Economic Cooperation and Development (OECD) maintains an ongoing project on Health Care Quality Indicators (HCQI) and whose goal is to develop a set of quality indicators that can be used to reliably assess quality of care across countries and raise questions about differences in quality of care internationally. Work is ongoing though a partnership between AHRQ and the Italian National Observatory on Health in the Italian Regions to test the AHRQ QIs with the Italian national hospital discharge data set. Preliminary results indicate that many of the operational issues associated with differences in coding schemes and data set structure are surmountable. With additional refinements on their clinical specificity, increased stability in their definitions over time to permit long-term monitoring and country interest within organizations such as the OECD to build on the existing scientific work of these indicators, their to help answer questions about patient safety worldwide will be significantly enhanced.
TL;DR: The goal of preventive medicine is to shed light on the network of CDDrelated risk factors in healthy subjects, thus allowing for primary preventive interventions aimed at removing harmful exposures, increasing host-defence mechanisms and activating targeted early-screening programs in susceptible individuals.
Abstract: Dear Sir, Chronic-degenerative diseases (CDD), including atherosclerosis, cancer and chronic-obstructive pulmonary diseases, are the main causes of death in developed countries, accounting for approximately 90% of mortality. These pathologies arise from a complex network of risk-factors both exogenous and endogenous in origin. The role of preventive medicine in counteracting this major public-health problem is pivotal, especially since treatment of these diseases is difficult. The goal of preventive medicine is to shed light on the network of CDDrelated risk factors in healthy subjects, thus allowing for primary preventive interventions aimed at removing harmful exposures, increasing host-defence mechanisms and activating targeted early-screening programs in susceptible individuals.CDD risk-factors are identified by anamnestic evaluation and questionnaires as well as chemical-laboratory analyses and the clinical examination of patients. For example, the risk assessment for atherosclerosis is performed by analysing diet and smoke-exposure habits, measuring blood pressure, lipid profile, etc., however, a similar approach may only in part be pursued for cancer because the majority of the related pathogenic phenomena occurs at molecular level.